Differential Diagnosis for Decompensated Cirrhosis with Abdominal Distension, SOB, Thrombocytopenia, and Pulmonary Embolism
- Single Most Likely Diagnosis
- Portal Hypertension with Hypersplenism and Cirrhotic Cardiomyopathy: This diagnosis is the most likely given the patient's decompensated cirrhosis, abdominal distension (likely due to ascites), shortness of breath (SOB), low platelet count (thrombocytopenia) due to hypersplenism, and the presence of multiple prominent collaterals in the upper abdomen indicating portal hypertension. The new small pulmonary embolism could be related to the cirrhotic cardiomyopathy or a separate thrombotic event.
- Other Likely Diagnoses
- Spontaneous Bacterial Peritonitis (SBP): Given the abdominal distension and decompensated cirrhosis, SBP is a possible diagnosis that needs consideration, especially if there are signs of infection or sepsis.
- Hepatopulmonary Syndrome (HPS): This condition is characterized by a defect in oxygenation due to pulmonary vascular dilatation in the setting of liver disease, which could explain the SOB.
- Portopulmonary Hypertension (POPH): A condition where there is pulmonary hypertension in the setting of portal hypertension, which could also explain the SOB and potentially the pulmonary embolism.
- Do Not Miss Diagnoses
- Budd-Chiari Syndrome: Although less common, this condition involves hepatic vein thrombosis, which could present with abdominal distension, ascites, and potentially pulmonary embolism if there is a right-to-left shunt or if the thrombosis extends into the inferior vena cava.
- Hepatic Artery Thrombosis: This is a rare but potentially catastrophic condition that could lead to liver infarction and should be considered, especially if there are risk factors for thrombosis.
- Rare Diagnoses
- Sinistral Portal Hypertension: This condition involves isolated left-sided portal hypertension, which could potentially explain some of the patient's symptoms but is less likely given the presence of cirrhosis and multiple collaterals.
- Congenital Portosystemic Shunt: A rare condition that could potentially explain some of the patient's findings, including the presence of collaterals, but is unlikely given the context of decompensated cirrhosis.